We carried out an unannounced inspection of Montrose Hall on 11 January 2017.

A comprehensive inspection was last carried out on 19 May 2015, when we rated the service as ‘requires improvement’ overall. We found no breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, however we did make one recommendation in relation to the safe storage of medicines, including controlled drugs at that time.

Montrose Hall is a modern, purpose built home situated within a local community in Wigan. It provides residential care for up to 41 older people, including people living with dementia. Accommodation is provided over two floors with lift access between the floors. Each floor has a main lounge with dining area and a second smaller lounge. On the day of the inspection there were 35 people living at the home, with two more people currently residing in hospital.

At the time of inspection the home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the home was clean throughout and had appropriate infection control processes in place. Hand hygiene guidance and equipment was located in all the bathrooms and there were posters encouraging the use of hand gels and regular washing to prevent the spread of infection on display.

Each of the people we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and were positive about the level of care provided. We saw the home had appropriate safeguarding policies and procedures in place, with instructions on how to report any safeguarding concerns to the local authority. Staff had received training in safeguarding vulnerable adults, which was regularly refreshed and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Staffing levels were determined by the needs of people living at the home, with a dependency tool being used each month to ensure levels remained safe and effective. We saw the home had sufficient numbers of staff to meet people’s needs and both people and relatives we spoke with confirmed this.

We saw medicines were stored, handled and administered safely and effectively. We noted some inconsistencies with the recording of ‘as required’ medications such as paracetamol, specifically with regards to the recording of occasions when people had not required these. Staff responsible for administering medicines were trained and had their competency assessed up to three times per year.

All staff spoken to demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We found the provider had followed the requirements in the DoLS and related assessments and decisions had been appropriately taken.

Staff were complimentary about the training available, telling us there was a mix between practical sessions and e-learning. All staff had completed a comprehensive induction programme lasting two full weeks and on-going training was provided to ensure skills and knowledge were up to date. Staff confirmed they received regular supervision and annual appraisals, which along with the completion of regular team meetings, ensured they were supported in their roles.

We observed meal times to be a positive experience, with people being supported to eat where they chose. Staff engaged in conversation with people,

We carried out an inspection of Montrose Hall on 19 May 2015. The inspection was unannounced.

At our last inspection on 23 May 2013 we found the service to be meeting the standards in all areas inspected.

Montrose hall is a modern purpose built home situated within a local community in Wigan. It provides residential care for up to 41 older people, including people living with dementia. At the time of our visit there were 41 people living at the home. Accommodation is provided over two floors with lift access between the floors. Each floor has a main lounge with dining area and a second smaller ‘quiet’ lounge.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe at Montrose Hall. Although some staff felt more staff were needed, we saw there were enough staff to meet people’s needs. Staff agreed that there were enough staff to keep people safe and ensure people received the support they required. Staff were able to tell us how they would identify possible abuse and they were confident action would be taken by the manager in response to any concerns. We saw risk assessments were carried out in relation to risks such as falls. Processes were in place to monitor when and where falls occurred so that necessary actions could be taken.

We saw that medicines were administered to people safely. However, some improvements were required to ensure medicines were kept safely. We saw the medicines trolley was left unattended with the keys in the lock on two occasions and the key for the controlled drugs cabinet was kept on top of the cabinet. This meant medicines were not kept as safely as they should have been, and could have been accessed by people living at the home. We have made a recommendation in relation to the safe storage of medicines.

The environment at Montrose Hall was bright, spacious and well kept. A number of adaptations had been made to the home to make it more dementia friendly. Adaptations included pictorial and directional signage, themed corridors, windows in doors and contrasting colours in bathrooms. Staff were able to relay what they had learnt in training they had received about dementia and what this meant in relation to providing effective support to people living with dementia.

People told us they liked the food provided. We saw that food was freshly prepared and that people were given a choice of meal and drink. Staff were aware of people’s dietary requirements, including for those who required diabetic meals. Not all staff had a good knowledge of the signs to look for that might indicate someone with diabetes had a high or low blood sugar. However, information on this was available in the care file. The manager said they were looking for training in this area.

The home was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of MCA and DoLS and understood what this meant in relation to the people they provided support to. The manager was making DoLS applications as required to the local authority and was tracking the outcome of the applications.

People told us the staff were kind and caring and respected their privacy and dignity. We saw interactions between staff and people living at Montrose Hall were friendly and compassionate. One staff member told us that you know everyone is there for the people living at the home. Relatives of people living at Montrose Hall that we spoke with told us they were kept up to date in relation to their family members care.

We saw pre-admission assessments were completed for anyone moving into the home. Some of the assessments were not very detailed. The manager told us the information available could sometimes be limited at the time of admission. We looked at the care file of someone who had recently moved in. Most of it had been completed as required, although a falls risk assessment was only partially complete. The care plans we looked at were person-centred and most had been regularly reviewed. However, one care plan we looked at had had a gap in review of around four months. This including records of weights.

Some people felt there was not enough to do at the home. Although regular entertainment was arranged to come into the home and there were trips out, day to day there was not a regular programme of activities. We saw staff put on music and DVD’s, however, they told us they could find it pressured to support activities in addition to other duties.

Staff and visitors we spoke with told us the service was well-led and the manager was approachable. We saw a wide range of audits were undertaken on a regular basis to help the manager monitor the quality and safety of the service. The staff we spoke with were happy working at the home and felt there was a good staff team.